Provider First Line Business Practice Location Address:
919 S GLENDALE AVE
Provider Second Line Business Practice Location Address:
UNIT A3
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91205-2803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-409-8910
Provider Business Practice Location Address Fax Number:
818-409-8930
Provider Enumeration Date:
11/20/2006